Managing Carpal Tunnel Syndrome

Carpal
tunnel syndrome (CTS) is the most commonly diagnosed nerve compression disorder
in the working population in the United States and abroad —and the most expensive
musculoskeletal disorder. My team and I see
attempts to relate CTS to all kinds of bodily injury claims…work-related or
not.

However,
as Shahriar Shahid notes in “The Economic Costs of
Carpal Tunnel Syndrome in the Workplace,” the costs of CTS go beyond
monetary losses. Workers with the
condition can no longer perform their duties and may have to change jobs and
some “undergo painful procedures from which they never recover and may
lose quality of life.”

The costs

No
one doubts that carpal tunnel syndrome has a huge impact on U.S.
businesses. While the exact dollar cost
of this injury is unknown, the expense to employers, workers, and insurance
companies from carpal tunnel and other ergonomic workplace injuries can run
into the billions. Shahid writes that between$2.7 billion and $4.8
billion per year is spent on the Medicare patient population alone.

Employers suffer indirect costs such as loss of productivity and time spent training new employees. Insurance companies and local governments bear a great deal of the economic burden as well. Looking at data from 2011 to 1023, the National Council on Compensation Insurance and OSHA estimate that the direct cost of the injury would be $28,647.

The human hand has 27 bones, not including the sesamoid bone, the number of which varies between people, 14 of which are the phalanges (proximal, intermediate and distal) of the fingers and thumb. The metacarpal bones connect the fingers and the carpal bones of the wrist.

The
indirect loss would be $31,511. The agencies project that a business would need
total additional sales of $2,005,266 to pay for all these expenses. While surgical costs vary regionally, these
range between $2,445 to $5,354 depending on care from an ambulatory center or
an acute care hospital.

Medical insights

The
hand, wrist, arm and shoulder are used in almost every activity during work and
at home. Constant use of the upper extremities increases the likelihood of
injuries, strains and cumulative trauma, something we see virtually every day
in claims and cases we review involvingrepetitive motion injuries.

A
frequent type of work-related upper extremity disorder is entrapment
neuropathy. The two most common neuropathies in the upper extremity are carpal tunnel and cubital tunnel. If these
conditions are treated early on, both may be resolved with conservative
measures. Surgical intervention may be
necessary when conservative measures have failed or when the nerve is severely
compressed.

Carpal tunnel involves the median nerve at the wrist level. Symptoms
usually start with nocturnal tingling and sometimes pain, typically in the
thumb, index, middle and one-half of the ring finger. If severe enough, the person will experience
motor impairment primarily seen in the muscle group at the base of the thumb.

Cubital tunnel involves the ulnar nerve at the elbow. The ulnar nerve is in
a superficial location at the medial elbow, so it is vulnerable to external
compression. Symptoms include pain, numbness in the ulnar side of the palm,
small finger and half of ring finger and weakness with gripping, pinching,
spreading fingers apart and holding them together. Other common signs of cubital tunnel include
Wartenburg’s sign (when the small finger cannot be held next to ring finger)
and Froment’s sign (hyperflexion of thumb interphalangeal joint). Both of these
signs are secondary to weakness of the musculature innervated by the ulnar
nerve.

The
clinician needs to understand the patient’s job demands and to consult with the
employer. This ensures appropriate education on posture, workstation set-up and
ergonomic tools available for use to provide the most favorable outcome.

Early
intervention can help prevent an employee from suffering from carpal or cubital
tunnel. Prevention of both diagnoses start with proper workstation ergonomics
and decreasing risk factors.

Finally,
remember the importance of having someone with the right medical training,
experience and bottom-line attitude on your team. For example, in non-workers comp claims in
which CTS is alleged, we’ve found that the condition is extremely rare as being
directly causally related, unless there is a significant, clearly documented
trauma such as a fracture to the wrist.